Welcome to Medicine Orientation Package Part A Name: Date: Page 1
WELCOME TO MEDICINE On behalf of the Leadership Team, we thank you for joining a very talented and patient focused team. We are committed to a culture of quality care for our patients and creating positive workplaces for our staff. We do our best to live our values every day. Respect, caring and trust are values that describe how we interact with our fellow employees, volunteers and physicians, and with our patients. Home is Best, is our philosophy of care. We know that home, not hospital, is the best place to recover from an illness or injury, to manage long term conditions and to live out final days. By ensuring that patients go home just as soon as they no longer need an acute care service, we reduce the risk of falls, pressure sores, and hospitalacquired infections. We are part of an integrated team of care providers that work as ONE TEAM, providing SEAMLESS CARE to our patients. This seamless care is essential to creating a better patient and provider experience, and also improving the health of the population and ensuring the future sustainability of the health care system. WHAT WE DO: Care for adult patients with medicine needs requiring hospitalization or specialized outpatient services. MODEL OF NURSING CARE DELIVERY: Across medicine we work as a collaborative team. The units are staffed by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Health Care Assistants (HCAs). Fraser Health values education and teaching and there will be many opportunities for you to work with students, new graduates and professionals from many disciplines. If you have concerns about your patient assignments due to competencies please speak to your Patient Care Coordinator (PCC), Charge nurse (CN) or Clinical Nurse Educator (CNE). TEAM WORK PRINCIPLES: Everyone is responsible for maintaining a respectful workplace: Answering all call lights Assisting visitors, families, and patients who come to the desk Promoting a positive welcoming learning environment When you have finished your work, ask your colleagues how you can help them Ask for help when you need it There is a possibility that you will be floated out to another unit PROFESSIONAL IMAGE AT WORK Nursing uniforms and Fraser Health (FH) identification badges are the expected dress code for direct care providers. Shoes are to meet the Worksafe BC Standards Hair that is longer than shoulder length is to be tidy and pulled back Please review the Professional Image Policy Personal electronic devices are not to be in view or in use while on shift. All sounds from these devices must be silenced. OTHER THINGS TO FIND OUT: Unit Staff Meeting frequency please make every effort to participate and stay informed. In order to create a strong team, it is an expectation for all staff to actively participate and/or lead in the unit s quality improvement projects. We encourage you to share your interests and talents with the team; i.e. wound care; hand hygiene auditor; Unit Professional Practice Councils. Page 2
MEDICINE REPORTING STRUCTURE CEO VICE PRESIDENT(S) EXECUTIVE DIRECTOR(S) DIRECTOR(S) OF CLINICAL OPERATIONS MANAGER(S) PCC(S) CNE EARL (Employee Absence Reporting Line): 604-605-3275 CISM (Critical Incident Stress Management): 1-866-584-7077 or 604-587-3707 EFAP (Employee and family assistance program): 1-800-505-4929 or 604-872-4929 OH&S (Occupational Health and Safety Work Related Injury Report Line) 1-866-922-9464 MY HOSPITAL S MAIN TELEPHONE NUMBER: _ Page 3
YOUR MEDICINE UNIT UNIT: TITLE NAME CONTACT NUMBER MANAGER PCC CNE PROGRAM CLERK UNIT: TITLE NAME CONTACT NUMBER MANAGER PCC CNE PROGRAM CLERK UNIT: TITLE NAME CONTACT NUMBER MANAGER PCC CNE PROGRAM CLERK OTHER: _ Page 4
ADMINISTRATIVE/OCCUPATIONAL HEALTH & SAFETY (OHS) I am aware of the unit layout I am aware of the Over Capacity Protocol (OCP) I am aware of the location of the sign in sheet on the unit I can access EARL I have completed my on-line New Employee Orientation (NEO) module & submitted my certificate DATE COMPLETED I I have completed the NEO Administrative OHS Checklist & submitted to manager I have access to Outlook I have completed a Meditech class; n/a for Employed Student Nurses (ESNs) I have access to Meditech I have accessed Course Catalogue Registration System (CCRS) & received education expectations I have my FH picture identification I have a name tag ordered I have obtained parking pass information I am aware of & have read Professional Image Policy I understand the Patient Safety Learning System (PSLS) & its purpose (tutorial available on the FH Pulse) I know how to access the Information Technology (IT) help desk for computer issues I know how to access MyinfoFraserHealth I have had a tour of the hospital & the unit I have been given cards (ie EFAP, Falls Prevention, etc.) PROFESSIONAL DEVELOPMENT I am competent to practice within my scope and understand my role under the Health Professions Act and the College of Registered Nurses of British Columbia (CRNBC) & College of Licensed Practice Nurses of British Columbia (CLPNBC) CRNBC Self- Learning Modules Available New Graduate LPN/RN Staff: Using my Competency, Assessment, Planning & Evaluation (CAPE) tool: I have completed my Self Evaluation I have started a self-learning plan I have set up a meeting to review my CAPE tool with the CNE DATE COMPLETED (RN only) I understand the relationship between the Health Professions Act (HPA)/CRNBC/FH & how they guide my practice RN Initiated Clinical Decision Support Tools (CDSTs) I can access the FH Clinical Policy Office for evidence-based CDSTs I can navigate my way to the FH Pulse intranet homepage from work & home I have access to the library & learning resources through the FH Pulse Page 5
FHA POLICIES AND PROCEDURES I can navigate FH Pulse to find Mosby s Skills for patient care clinical procedures (complete tutorial if needed) I can access the online FH Parenteral Drug Therapy Manual (PDTM) I can access and have read: Reducing Consecutive Shifts to Minimize Fatigue, Errors and Injuries Policy Respectful Workplace Policy Electronic Communications Professional Image DATE COMPLETED l I understand where the infection control policies & resources are on the intranet I understand Safe Client Handling & have reviewed the policy I have an awareness of the policies and procedures for the Provincial Violence Prevention Curriculum (PVPC) via FH Pulse/CCRS Needs to be completed within 3 months of being hired NOTES: Page 6
CLINICAL SCENARIOS #1 MRS. SHEER PATIENT & MEDICAL HISTORY: Mrs. Sheer is a 63 year old female, admitted early this morning during night shifts with a diagnosis of bilateral pneumonia. She is an insulin dependent diabetic with a history of a right sided mastectomy for breast cancer 5 years ago. Mrs. Sheer is a teacher who lives with her husband and has 2 supportive daughters. It is your first day shift and you arrive on the unit at 0730 and begin reviewing the 48/6 & shift report. Mrs. Sheer had several episodes of hypoxemia during the night and the report indicates she is settled at the moment. No other variances were reported. She has a peripheral IV in her left arm infusing NS @ 50cc/hr with her initial dose of antibiotics currently infusing. She is now on O 2 via nasal prongs at 5L/min and on nights her vitals are within the normal range. On first rounds you observe Mrs. Sheer is anxious and short of breath. You proceed to check her vitals and blood sugar levels. The results are: VITALS: B/P HR RR SaO2 Temp 0750 97/48 124 36 87% 37.4 BLOOD SUGAR: 10.5 HEAD TO TOE ASSESSMENT: You complete a head to toe assessment immediately and when auscultating the lungs you discover Mrs. Sheer has a rash to her torso. CURRENT MEDICATIONS: Sliding Scale Insulin; NPH insulin; Ceftriaxone IV & Ventolin nebulizers Take a moment to reflect what your concerns are and how you would proceed? 1.) Does this patient require Escalation of Care? And Why? 2.) Who would you notify? 3.) You suspect the patient is hypoxic what do you do? 4.) You suspect an anaphylactic reaction what do you do? Page 7
ANSWER KEY FOR CLINICAL SCENARIO # 1 1.) Yes this patient requires Escalation of Care. CLICK HERE for resources The following are concerns as they are not within patient s normal limits: Increased HR, RR & Blood Sugar Decreased SaO2 with an increase in supplemental oxygen Decreased BP Anxious & SOB Torso rash 2.) Notify PCC/CN, RT, MRP a. Locate the process at your site for notifying site supports b. Complete SBAR & locate where the form is stored on your unit, if not available you can CLICK HERE for a copy c. CLICK HERE for CCRS SBAR course & complete 3.) HYPOXEMIA MANAGEMENT: a. Find & review the Adult Hypoxemia Management Clinical Practice Guideline (RNAI) b. Review the hypoxemia power point CLICK HERE for the link c. Initiate the minimal amount of oxygen to reverse hypoxemia. Mrs. Sheer is already on 5L/min via NP therefore she would need to be increased to 5-10L/min via mask. d. Focus Chart: Initial and ongoing assessment. Diagnosis of actual/suspected hypoxemia. Date/time oxygen initiated. Method and flow of oxygen. Client response to treatment. Consultation with HCP & RT e. Doctor s Order form: Date, time, method, flow and rationale. 4.) ANAPHYLAXIS MANAGEMENT: Anaphylaxis is a serious and potentially fatal systemic allergic reaction.2 immediate treatment with EPINEPHrine can be lifesaving. a. Find & Review the Anaphylaxis Management Clinical Practice Guideline (RNAI) b. Review the hypoxemia power point CLICK HERE for the link c. Administer 0.5 mg (0.5 ml) EPINEPHrine 1:1000 IM into thigh (vastus lateralis) which is the preferred site or IM site opposite to or away from the site of causative agent. This can be repeated every 5 minutes (maximum 3 doses). d. Focus Chart: see above 5d e. Doctor s Order form: see above 5e f. Monitor vital signs every 5 minutes to detect deterioration or adverse reaction to medication administration or initiate cardiac arrest management as per client situation. Escalation of care may be required if patient not responding. IMPORTANT NOTE: Any registered Nurse Initiated Activity (RNAI) can only be initiated by a RN so if you are an LPN in this situation please notify the Charge Nurse & RN partner. It will still be beneficial for LPN s to review Page 8
#2 MR. ROYAL PATIENT & MEDICAL HISTORY: Mr. Royal, 79 years old was admitted with recent onset of confusion, weight loss and inability to cope at home. He has a history of hypothyroidism, falls and frequent recurring pneumonias. He is a widower who lives alone in an apartment; all 4 of his children live in other provinces. The porter has just settled him into one of your assigned beds. 1.) a. How would you proceed with the admission of Mr. Royal? b. Is this patient LPN appropriate? On admission he appears emaciated and has open pressure sores to coccyx and heels. During your assessment, Mr. Royal becomes increasing suspicious and agitated making statements like You cannot keep me here, what do you think you are doing? You better leave and let me get out of here. His vital signs are within his normal range; his lungs have faint crackles bilaterally with satisfactory breath sounds. No peripheral edema is noted. 2.) What are your next nursing actions and interventions? Three days later, Mr. Royal demonstrates an increase in confusion and has more frequent intermittent bursts of verbal aggression with threats of physical harm to the nurses. When changing the dressing to the coccyx, you note an increase in wound size and a small amount of yellow discharge. VITALS: B/P HR RR SaO2 Temp Admission 124/82 84 18 97% 36.5 Day 2 114/80 92 20 95% 1 L/min 37.1 Day 3 98/55 110 26 94% 5L/min 37.4 3.) a. What do you think is happening with Mr. Royal? b. What are your next steps? Take a moment and reflect on how urgent you think the situation is and how you would prioritize c. What other information would you want to know? Page 9
ANSWER KEY FOR CLINICAL SCENARIO #2 1.) a. Admission Ensure patient Safety Questionnaire is completed and if not complete then start the48/6 care plan CCRS 48/6 course CLICK HERE Follow Care Standards for Medicine in regards to admitting a patient. CLICK HERE for the link to The Care Standards Review MOST or give patient information about MOST/ACP CLICK HERE for the MOST Policy and other resources Ensure Universal Falls Prevention measures are in place b. RN/LPN Scope of Practice 2.) Recognizing Mr. Royal s risks Complete Risk assessment for Aggressive Violent Behavior (AVB) Mr. Royal is displaying challenging behaviours. Create a care plan in 48/6 for managing the behaviours Review CRBAC tools Practice completing a CAM assessment Review the Least Restraint Protocol 3.) Clinical Assessment a. Sepsis Click Here for a Sepsis Power Point Presentation b. A number of different tasks would need to take place and you may need to delegate Escalate care & notify MRP Laboratory data, Review vital sign trends Assess for any behavioural changes Complete a full comprehensive physical assessment c. The other information that would be useful: A recent CAM assessment comparing previous score Delirium, please see below for useful resources. It is important to understand the differences between dementia and delirium NOTE: For a detailed list of available Fraser Health resources (Mosby s, Clinical Policies, Clinical Practice Guidelines etc. related to Dementia, Least Restraints, Delirium Click Here NOTE: Available and suggested courses to complete on CCRS: Delirium, Sepsis, Least Restraints, 48/6 Care Standards, Falls and MOST. These can all be completed from home. CLICK HERE for the CCRS home page link Page 10